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Hospital unit understaffing and missed treatments: primary evidence

Ashley Y. Metcalf (College of Business, Ohio University, Athens, Ohio, USA)
Yong Wang (West Chester University, Philadelphia, Pennsylvania, USA)
Marco Habermann (College of Business, Ohio University, Athens, Ohio, USA)

Management Decision

ISSN: 0025-1747

Article publication date: 18 May 2018

Issue publication date: 24 September 2018




Hospitals throughout the USA are facing increasing patient demand and employee shortages. This capacity issue has led to understaffing in some hospital areas. The purpose of this paper is to examine the understaffing in hospital-unit respiratory care and the impact to error rates, specifically missed treatments rates. The moderating effects of teamwork and standardized, integrated information systems are also considered.


Survey methodology is used for data collection of respiratory care managers within hospital units. Regression is used to test the hypotheses in this study.


The regression results show that higher rates of understaffing are associated with more missed treatments. In addition, both teamwork and integrated information systems are associated with lower missed treatments. Finally, the moderating effect of teamwork is also highly significant within the model while integrated information systems are not a significant moderator.

Practical implications

Managers working within understaffed hospital units can try to reduce missed treatment rates by both integrated information systems and teamwork among employees. Additional benefits can be gained from teamwork due to the indirect effects (moderating effects) as well. This indicates teamwork training can be useful for quality initiatives.


Understaffing is associated with higher missed treatments in hospital units. Standardized, integrated information systems within a hospital are associated with less missed treatments. Furthermore, employee teamwork within a hospital unit is associated with a direct effect on missed treatment rates as well as an indirect effect by weakening the negative impact of understaffing.



Metcalf, A.Y., Wang, Y. and Habermann, M. (2018), "Hospital unit understaffing and missed treatments: primary evidence", Management Decision, Vol. 56 No. 10, pp. 2273-2286.



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